BEYOND THE PACK: HOW PICTORIAL WARNINGS SHAPE PERCEPTION AND BELIEF AMONG SMOKERS

Abstract

This study explores how pictorial health warnings (PHWs) on cigarette packages influence perceptions of threat and efficacy among smokers and non-smokers in Sleman District, Yogyakarta, using the Extended Parallel Process Model (EPPM) as the guiding framework. Employing a qualitative grounded theory design, nineteen participants—comprising both smokers and non-smokers—were interviewed using five official Indonesian PHWs as visual stimuli. Findings show that the blackened lung, oral cancer, and throat cancer images elicited the strongest perceptions of severity, often provoking fear and disgust, while the smoker near a child image generated mixed responses depending on personal relevance. Perceived susceptibility was higher among non-smokers, particularly regarding second-hand smoke exposure. Response efficacy was generally high, but self-efficacy varied greatly, with low self-efficacy often linked to defensive avoidance among smokers. Personal experiences with smoking-related illness and the realism, clarity, and emotional salience of images significantly shaped message reception. The study concludes that PHWs are most persuasive when they combine high threat with high efficacy, are contextually relevant, and are supported by cessation resources, offering critical insights for strengthening tobacco control strategies in Indonesia